On the pulse

“We cannot continue to invest in the same service models of the past. We need a radical shift in how the NHS sees itself, from a hospital service for the ill, to a nationwide service to keep us healthy.”

Student subscription

Jaundice

Jaundice is a term that is used to describe a yellow coloured tinge to the skin, and a yellowing of the whites of the eyes. The body fluids of someone who is affected by jaundice can also become yellow in colour.Brought to you by NHS Choices

Overview

Introduction

The medical name for jaundice is icterus.

Bilirubin

Jaundice is caused by the build up of bilirubin in the blood. Bilirubin is a yellow coloured substance that is produced when red blood cells are broken down.

Normally, the liver ‘picks up’ bilirubin and it is filtered by the kidneys, before being excreted (passed out) of the body in urine. However, if there is something wrong with the liver, or the biliary system (which produces a waste substance called bile), an excess amount of bilirubin is produced.

Neonatal jaundice

Jaundice is very common in newborn babies. It occurs as a result of the liver being underdeveloped and not fully functional. In most cases, neonatal jaundice is nothing to worry about, it requires no treatment, and usually disappears after a week or so.

See the ‘causes’, ‘treatment’, and ‘useful links’ sections for more information about neonatal jaundice.

Jaundice in adults and older children

Jaundice that occurs in adults and older children is usually a sign of an underlying health problem. There are three types of jaundice which are described below.

Hepatocellular jaundice

Hepatocellular jaundice is the most common type of jaundice. It occurs when bilirubin is unable to leave the liver cells and cannot be removed from the body by the kidneys. Hepatocellular jaundice is usually caused by liver failure, liver disease (cirrhosis), hepatitis (inflammation of the liver), or by taking certain types of medication.

Haemolytic jaundice

Haemolytic jaundice is where too much bilirubin is produced as a result of a large number of red blood cells being broken down. This can be due to a number of conditions, such as anaemia, or a problem with the metabolism (the way that the body produces and uses energy).

Obstructive jaundice

Obstructive jaundice occurs when there is an obstruction (blockage) in the bile duct, which prevents bilirubin from leaving the liver. This type of jaundice is usually caused by a gallstone, a tumour, or a cyst in the bile duct, or pancreas.

Symptoms

Symptoms of jaundice

Yellow skin is the main symptom of jaundice

The most obvious sign of jaundice is a yellow tinge to the skin and the whites of the eyes.

The yellowing of the skin is usually first noticeable on the head and face, before spreading down the body. In people with dark skin, yellowing of the whites of the eyes is often more noticeable.

Other symptoms

Depending on the cause of your jaundice, as well as a yellowing of the skin, you may also have other symptoms including:

tiredness,

abdominal pain,

weight loss,

vomiting, and

fever - a temperature of 38C (100.4F), or above.

If you have obstructive jaundice, your skin may be very itchy. Your urine will also probably be darker than usual, and your stools may be paler.

Causes

Causes of jaundice

The liver is a very important organ. One of the functions of the liver is to ‘pick up’ and remove bilirubin (a yellow coloured substance) from the body.

Jaundice is caused by excess bilirubin

Bilirubin is produced when red, oxygen-carrying, blood cells are broken down. The bilirubin is transported in the bloodstream to the liver which usually removes it from the blood so that it can be excreted (passed) from the body in urine.

However, if there is too much bilirubin in the blood, or if, for some reason, the liver cannot get rid of it, the excess will cause jaundice.

Jaundice usually occurs as a result of a separate health condition which causes a build up of bilirubin, or prevents the liver from functioning properly and disposing of bilirubin.

Some common conditions that can cause jaundice are outlined below.

Acute hepatitis

Acute hepatitis is a condition that causes inflammation (swelling) of the liver, usually as a result of the hepatitis A, B, C, D, or E viruses.

Acute hepatitis can also develop as a result of drinking excess amounts of alcohol over a long period of time, or taking certain types of medication.

Obstruction of the bile ducts

If the bile ducts (tiny tubes in the liver that remove bile) become blocked - for example, by a gallstone - or if they are damaged - for example, by a condition such as cirrhosis (a serious condition that destroys healthy liver tissue) - the obstruction, or damage, can result in a build up of bilirubin.

Haemolytic anaemia

Haemolytic anaemia can occur when a large number of red blood cells are destroyed, leading to an increase in the production of bilirubin.

Haemolytic anaemia may be caused by a blood-borne disease, such as malaria, or an autoimmune disease (where the body’s immune system, which helps prevent infection, attacks healthy cells and tissue).

Gilbert’s syndrome

Gilbert’s syndrome is a condition that affects approximately 3% of the UK population. It is an inherited condition (it runs in families) that adversely affects the ability of enzymes (proteins that cause chemical reactions between other substances) to function properly, and process the excretion of bile. People with Gilbert’s syndrome will sometimes experience mild jaundice.

See the ‘useful links’ section for more information about Gilbert’s syndrome.

Neonatal jaundice

Neonatal jaundice is very common with around 50% of all newborn babies being affected. It often occurs as a result of the baby’s liver not being fully developed, which means that it is unable to deal with bilirubin.

Neonatal jaundice often occurs 2-4 days after birth, and usually clears up without treatment, around 7-10 days. However, if jaundice lasts for longer than this, further investigations to find out whether there is another underlying cause will be needed.

Other, rarer conditions

As well as the conditions outlined above, there are also a number of other, rarer conditions that can cause jaundice. These are listed below.

Crigler-Najjar syndrome - an inherited condition that adversely affects the enzyme responsible for processing bilirubin, leading to an excess build up of bilirubin.

Dubin-Johnson syndrome - an inherited condition that prevents bilirubin from being secreted (passed out) of the liver’s cells.

Rotor’s syndrome - an inherited condition that is similar to Dubin-Johnson syndrome, but does not involve the retention of bilirubin in the liver’s cells.

Pseudojaundice - a harmless type of jaundice that is unrelated to bilirubin, where the skin turns a yellowish colour due an excess amount of beta-carotene in the blood (carotenemia), usually from eating large quantities of carrots, pumpkin, or melon.

Diagnosis

Diagnosing jaundice

If you have jaundice, you will have a number of tests in order to find out how severe it is, and to determine the underlying cause.

Liver function and blood testing

The first tests that you have will help establish whether or not your liver is functioning properly.

If the cause of your symptoms cannot be identified, you may be tested for hepatitis, and you may also have a blood test in order to evaluate the make up of your blood, and check the levels of bilirubin.

If you have jaundice, some of the tests you are likely to have include:

hepatitis A,

hepatitis B,

hepatitis C,

full blood count (fbc), and

liver function tests (including total bilirubin).

You may also have two other tests:

conjugated bilirubin test (bilirubin that has been taken up by the liver in order to be excreted in bile), and

unconjugated bilirubintest (bilirubin that is circulating freely in the blood).

Testing for an obstruction in the liver

If an obstruction in your liver is suspected, you may have a scan in order to determine your liver’s structure. Your gallbladder and bile ducts will also be looked at. Imaging tests that you may have include:

abdominal ultrasound,

computerised tomography (CT) scan,

magnetic resonance imaging (MRI) scan,

cholangiography (a scan of the bile ducts), and

endoscopic retrograde cholangiopancreatography (ERCP).

You may also have a liver biopsy. This involves a small sample of your liver tissue being removed under local anaesthetic, so that it can be examined under a microscope. If you need to have a liver biopsy, you may need to stay in hospital overnight.

Treatment

Treating jaundice

The treatment of jaundice in adults and older children will depend on the underlying condition that is causing it.

After having a number of different tests (see the ‘diagnosis’ section) to determine the cause of your jaundice, the appropriate treatment will be recommended.

Anaemia

Anaemia is a condition that occurs when there is a reduced number of red blood cells, or a reduced concentration of haemoglobin (a substance that stores and carries oxygen in red blood cells). There are a number of different types of anaemia and each type has a different cause.

If your jaundice is being caused by anaemia, you may need to increase the amount of iron in your blood by taking iron supplements, or by including more iron-rich foods in your diet.

See the ‘useful links’ section for further information about anaemia.

In cases of autoimmune haemolytic anaemia (where the body’s immune system attacks healthy red blood cells), treatment with corticosteroids may be required. However, if corticosteroids fail to successfully control the condition, immunoglobulin (IgG) may be recommended.

Immunoglobulin is a type of protein that functions as an antibody (a substance that fights infection).

Hepatitis

Hepatitis is a condition that is caused by a virus, and results in inflammation of the liver. There are several types of hepatitis virus that can infect the liver. Hepatitis A and B are the most common types.

If your jaundice is caused by hepatitis, you might need to take anti-viral, or steroid, medication. However, not all types of hepatitis can be treated.

See the ‘useful links’ section for further information about hepatitis.

Cirrhosis

Cirrhosis (liver damage) is a serious condition that destroys healthy liver tissue, leaving scar tissue that can block the flow of blood through the liver. Cirrhosis progresses slowly, gradually causing the liver to stop functioning.

Cirrhosis cannot be cured, but treatment can slow the condition’s progress. Treatment also aims to reverse any liver damage that has already occurred. If you have cirrhosis, depending on the underlying cause, you may be prescribed medication, and/or advised to cut down on your consumption of alcohol.

See the ‘useful links’ section for more information about cirrhosis.

Obstruction

If your jaundice is caused by an obstruction, such as a gallstone, or a tumour, you may need surgery in order to remove it.

Gallstones are usually treated by surgically removing your gallbladder, using a procedure called a cholecystectomy. A cholecystectomy is minimally invasive surgery (‘keyhole’ surgery), where a small incision is made.

However, in about 10% of cases, keyhole surgery is not possible and an open cholecystectomy is required, where the gallbladder is removed through a larger incision in the abdomen.

See the ‘useful links’ section for more information about gallstone removal.

Gilbert’s syndrome

Gilbert’s syndrome is a harmless condition that does not cause any symptoms. It produces a build up of bilirubin in the blood, which is usually removed by the liver. However, in people with Gilbert’s syndrome, the liver is unable to remove bilirubin from the body, and mild, temporary jaundice can occur.

There is no treatment for Gilbert’s syndrome, but you should inform health professionals that you have the condition if you need to have hospital tests.

See the ‘useful links’ section for more information about Gilbert’s syndrome.

Medication

If your jaundice is caused by taking a particular type of medication, your GP might be able to prescribe an alternative for you.

Neonatal jaundice

In most cases, neonatal jaundice disappears on its own, after 7-10 days, without any treatment. However, if jaundice persists after this time, phototherapy, also known as light therapy, may be needed.

During phototherapy, the baby is exposed to ultraviolet (UV) light, usually for a period of 1-2 days. The UV light breaks down the bilirubin, making it easier for the baby’s liver to get rid of. If phototherapy does not work, and the levels of bilirubin are very high, a blood transfusion may be needed.

See the ‘useful links’ section for more information about how neonatal jaundice is treated.

Prevention

Preventing jaundice

Jaundice often develops as a result of an underlying health condition and can therefore be difficult to prevent.

However, jaundice is related to the functioning of the liver, so it is very important that you take steps to keep this vital organ healthy and working properly.

In order to do this, you should ensure that you lead a healthy lifestyle by eating healthily, exercising regularly, and not drinking more than the recommended daily amounts of alcohol.

Diet

Make sure that you eat a healthy, balanced diet that is low in saturated fat, and contains at least five portions a day of a variety of fruit and vegetables.

It is also very important to drink plenty of fluids. You should drink a minimum of 1.2 litres (eight glasses) of water a day, plus more in hot weather and when exercising.

See the ‘useful links’ section for more information about diet.

Exercise

In order to remain fit and healthy, you should exercise at least five times a week, for a minimum of 30 minutes each session.

The exercise that you do should raise your heart and breathing rates, and leave you slightly sweaty and out of breath afterwards. Visit your GP for a health check if you have not exercised before, or for a long period of time.

See the ‘useful links’ section for more information about exercise.

Alcohol

Drinking excessive amounts of alcohol can have serious consequences for your health. For example, it can lead to serious conditions, such as cirrhosis (liver damage).

Therefore, it is very important that you do not drink too much alcohol. The Department of Health recommends that men should drink no more than 3-4 units of alcohol a day, and that women should drink no more than 2-3 units a day.

A unit of alcohol is equal to about half a pint of normal strength lager, cider, or bitter, a pub measure (25ml) of spirits, or a 50ml pub measure of fortified wine, such as sherry, or port.

See the ‘useful links’ section for further information about alcohol and alcohol misuse.

Have your say

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.

Unlimited access to Nursing Times...

...gives you the confidence to be the best nurse you can be. Our online learning units, clinical practice articles, news and opinion stories, helps you increase your skills and knowledge and improves your practice.